Traumatic brain injuries can be difficult to identify in adults, but diagnosing them in young children presents an even greater challenge.
A toddler may not have the vocabulary to explain that their ears are ringing, their vision is blurry, or their head hurts. Very young children also have little academic, social, or employment history that doctors and attorneys can use to compare who they were before the injury with how they function afterward.
During this episode of Mind Matters: Navigating Head Injuries and Concussions, treatment coordinator and registered nurse Kiley Como spoke with attorney John Mobley of Shane Smith Law’s concussion and brain injury group. They discussed why pediatric TBIs can be difficult to diagnose, which symptoms parents should watch for, and how an injury may affect a child’s development for years.
Why Pediatric Brain Injuries Are Different
A traumatic brain injury occurs when an external force disrupts normal brain function.
Possible causes include:
- Car accidents
- Falls
- Direct impacts
- Penetrating injuries
- Oxygen deprivation during birth
When evaluating an adult, medical and legal professionals can often compare the person’s abilities before and after the injury.
They may review job performance, grades, hobbies, relationships, and previous medical records.
That comparison is much harder with a baby or toddler who has not yet reached many developmental milestones.
There may be no school history, employment record, or established skill level showing what the child could do before the injury.
Young Children Cannot Always Explain Their Symptoms
Older children and adults may be able to report headaches, dizziness, memory problems, or ringing in the ears.
A preverbal child cannot.
Even children who can speak may not understand what they are experiencing or know the words needed to describe it.
They may not be able to explain:
- Double vision
- Light sensitivity
- Vertigo
- Tinnitus
- Confusion
- Mental fatigue
- Difficulty concentrating
Instead, their symptoms may appear as crying, irritability, withdrawal, sleep changes, or unusual behavior.
Parents Become the Medical Historians
Parents and caregivers often know the child better than anyone else.
They may notice subtle changes that are not obvious during a short medical appointment.
Important observations may include:
- Lower energy
- Increased crying
- Changes in appetite
- Trouble sleeping
- Loss of interest in toys
- Balance problems
- Increased falls
- Sensitivity to light or noise
- Difficulty interacting with others
John recommended keeping a journal of symptoms and behavior.
Recording when changes begin, how often they occur, and what seems to trigger them can provide valuable information to physicians and therapists.
Some Problems Do Not Appear Until Years Later
A pediatric brain injury may not become fully apparent immediately.
A young child may appear to function normally at home because very little is being demanded of the injured brain.
Problems may emerge later when the child enters school and must read, solve math problems, follow instructions, remember assignments, and interact with classmates.
The injury may affect skills that had not yet developed at the time of the accident.
That means the full impact may not become visible until the child reaches a later developmental stage.
Changes in Energy and Behavior
Fatigue can be an important pediatric TBI symptom.
A child who was previously active and playful may appear unusually tired, withdrawn, or disconnected.
Parents may notice that the child:
- Stops participating in activities
- Needs more naps
- Becomes overwhelmed easily
- Loses interest in other children
- Appears emotionally flat
- Becomes unusually irritable
These changes may be mistaken for normal childhood behavior unless the family considers how the child acted before the accident.
Nausea and Vomiting
Nausea and vomiting can be warning signs after a head injury.
A young child may not be able to say that they feel nauseated. Vomiting may be the first visible indication that something is wrong.
Vomiting after a collision or head impact does not confirm a specific brain injury, but it should be reported promptly to a medical professional.
Repeated vomiting, worsening sleepiness, confusion, seizures, or loss of consciousness may require emergency evaluation.
Headaches May Look Like Crying
Headaches are among the most commonly reported TBI symptoms.
A baby or toddler may not be able to identify or describe head pain.
The discomfort may instead appear as:
- Persistent crying
- Holding or rubbing the head
- Avoiding light
- Becoming upset in noisy places
- Refusing normal activities
- Difficulty sleeping
Parents should explain these behavioral changes to the child’s medical provider rather than assuming the child is simply being difficult.
Balance and Coordination Problems
A brain injury can interfere with balance, movement, and coordination.
These symptoms can be difficult to evaluate in a child who is still learning to walk or naturally falls often.
Parents may notice:
- More frequent falls
- Unsteady walking
- Trouble climbing stairs
- Difficulty reaching for objects
- Reduced participation in sports
- Changes in fine motor skills
Long-term balance problems may also increase the child’s risk of future falls and injuries.
Light and Sound Sensitivity
Children with brain injuries may become unusually sensitive to bright lights or loud sounds.
A child may squint, cover their eyes, avoid sunny areas, or become distressed in stores, classrooms, or crowded rooms.
Sound sensitivity may appear as covering the ears, crying during normal household noise, or withdrawing from busy environments.
These reactions can offer clues when the child cannot explain what they feel.
Ringing in the Ears
Tinnitus is the perception of ringing, buzzing, or another sound that does not come from an outside source.
A young child may have no way to describe it.
Tinnitus can interfere with:
- Sleep
- Hearing speech
- Concentration
- Classroom performance
- Emotional well-being
John discussed the value of objective testing when evaluating children who cannot communicate these symptoms clearly.
A hearing specialist or another appropriate provider may be needed when auditory changes are suspected.
Vision Problems After a Pediatric TBI
Brain injuries can affect how the brain processes visual information.
Possible symptoms include:
- Blurred vision
- Double vision
- Difficulty focusing
- Seeing spots
- Abnormal eye movements
- Trouble following moving objects
A child may bump into objects, avoid reading, close one eye, tilt the head, or become frustrated during visual activities.
A routine eye examination may not identify every neurological vision problem.
Depending on the symptoms, a neuro-ophthalmologist or another specialist familiar with brain injuries may be appropriate.
Testing May Require Several Approaches
No single test reveals every pediatric brain injury.
The evaluation may involve:
- Medical history
- Parent observations
- Neurological examinations
- CT or MRI scans
- Balance testing
- Vision and hearing evaluations
- Developmental assessments
- Cognitive or academic testing
- Follow-up over time
The transcript also discussed advanced imaging and emerging blood testing as tools that may provide additional information in selected cases.
However, test results must still be considered alongside the child’s symptoms, development, and accident history.
School Performance Can Reveal Hidden Difficulties
Once the child begins school, teachers may notice problems that were difficult to see at home.
Possible signs include:
- Difficulty learning new material
- Poor reading comprehension
- Reduced attention
- Memory problems
- Slower work
- Behavioral changes
- Trouble following instructions
- Difficulty making friends
Academic records can help show how the child’s abilities develop over time.
Teachers, school counselors, therapists, and parents may all contribute important information.
Social and Vocational Effects May Last Into Adulthood
A pediatric brain injury can affect more than school performance.
Long-term difficulties may influence the child’s ability to:
- Build friendships
- Participate in sports
- Live independently
- Complete higher education
- Maintain employment
- Manage money
- Drive safely
- Participate in community activities
Because the child has an entire lifetime ahead, estimating future needs can be complicated.
The full consequences may not be known for many years.
Future Care Can Be Extensive
Some children with serious brain injuries may need long-term assistance.
Possible future care may include:
- Neurology appointments
- Vision or hearing treatment
- Physical therapy
- Occupational therapy
- Speech therapy
- Psychological care
- Educational support
- Assistive technology
- In-home assistance
A life care planner may help estimate the services, equipment, and expenses the child could need over a lifetime.
It Takes a Village
Kiley and John emphasized that identifying a pediatric brain injury often requires help from many people.
Parents, relatives, teachers, physicians, therapists, and other caregivers may each notice different parts of the child’s condition.
No single person sees the child in every environment.
Sharing observations and documenting changes can help the medical team understand the complete picture.
Early Evaluation Matters
Parents should seek medical attention when a child experiences concerning symptoms after a car accident, fall, or head impact.
They should report changes in behavior, sleep, balance, appetite, vision, hearing, energy, and school performance.
A child may not be able to explain that something is wrong.
Careful observation, appropriate testing, and continued follow-up may be the best tools available for identifying the injury and helping the child receive treatment as early as possible.
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